Latino Health – State of Healthhttps://ww2.kqed.org/stateofhealth
KQED Public Media for Northern CAThu, 08 Dec 2016 19:25:40 +0000en-UShourly1https://wordpress.org/?v=4.2.2Rise of Latino Political Power in Sacramento Could Give New Momentum to Health Carehttps://ww2.kqed.org/stateofhealth/2016/03/04/latino-political-power-in-sacramento-health-care/
https://ww2.kqed.org/stateofhealth/2016/03/04/latino-political-power-in-sacramento-health-care/#commentsFri, 04 Mar 2016 18:47:00 +0000http://ww2.kqed.org/stateofhealth/?p=156627When Anthony Rendon, D-Paramount, is sworn in as Assembly Speaker Monday, it will mark a historic moment in California politics: For the first time, the two top posts in the state legislature will be held by Latinos.

Rendon will join Senate President Pro Tem Kevin de León, D-Los Angeles, at the top of the Capitol’s political pyramid, a development that could signal much brighter prospects for health care legislation — especially the effort to provide adult immigrants who are living here illegally with coverage under Medi-Cal, the government program for people with low incomes.

“What we’re witnessing is a dramatic surge in power. I think it will be a new and dramatic change in California,” said Jaime Regalado, a political science professor emeritus at California State University Los Angeles.

The power of the Latino caucus in the state, he said, has reached a point where the top items on its agenda are becoming the top items on the legislature’s agenda.

That agenda is weighted toward health care and education, he noted — from Medi-Cal expansion to paid sick leave to health coverage for children of those in the United States illegally.

Aside from Rendon and de León, other Latino leaders in Sacramento also play a big role in Capitol health care politics, including Ed Hernandez, D-West Covina, who heads the Senate Committee on Health and has authored dozens of health-related bills; Lorena Gonzalez, D-San Diego, in Assembly Health, who spearheaded the mandate for paid sick leave; and Ricardo Lara, D-Bell Gardens, who wrote the bill to provide Medi-Cal coverage to children of people living in the United States.

“Everybody has been calling [the Latino community] the sleeping giant for so many years. But it has been awake for some time now,” Regalado said. “Latinos have always been concerned about their communities, and they have had the highest proportion of those without health care, so Latino leaders are going to rank those issues high on their list.”

Three years after the advent of Covered California and the expansion of Medi-Cal, nearly three-quarters of the roughly 3 million remaining uninsured in the state are Latino, according to a January 2015 study by UCLA and UC Berkeley researchers.

This year the wish list of Latino leaders includes a bill sponsored by de León to provide housing and mental health treatment for the chronically homeless — many of whom suffer from mental illness. And following last year’s successful move to offer full Medi-Cal coverage to undocumented children in California, the next step is to extend it to their adult counterparts, according to Rendon.

“It’s important, and it’s important now,” said incoming Assembly Speaker Rendon in an interview at last Saturday’s state Democratic convention in San Jose. “Covering undocumented immigrants is certainly something that resonates with me from a personal point of view, and from the caucus point of view it’s really high on our list.”

Rendon noted that de León’s background also makes the Senate leader sympathetic to the goal of providing coverage for immigrants without legal documents. Because it requires heavy political lifting, he said, “it certainly needs to be near the top of the agenda to succeed.”

Before he joined the Assembly in 2012, Rendon was executive director of the nonprofit Plaza de la Raza Child Development Services, which provides social and medical services to children in Pico Rivera, east of Los Angeles. De León spent time as a community organizer for immigrant rights before becoming a member of the legislature in 2006.

Though Medi-Cal for immigrant children without papers was approved and will take effect in May, providing that coverage for adults with the same immigration status is highly controversial and promises to be a tough political slog.

“In general, the direction the legislature has taken over the past decade or two has been to serve people who are in California illegally, and that takes benefits from other people,” said Ira Mehlman, spokesman for the Washington, D.C.-based Federation for American Immigration Reform, which lobbied in Sacramento against “Medi-Cal for all” when it was first put before the legislature last year.

“We think that just encourages people who violate laws, and deprives other people in the state of needed resources,” Mehlman said.

Regalado said that despite strong opposition, Medi-Cal coverage for the adults could succeed with the expected political push from Rendon and de León.

“They will be emboldened,” Regalado said. “They have enormous political power right now.”

Rendon said access to health care, especially in rural areas, will also be a top legislative priority.

The amount spent on Medi-Cal could change too, said Gerald Kominski, director of the UCLA Center for Health Policy Research.

Since the expansion of Medi-Cal began under the Affordable Care Act, enrollment in the program has expanded significantly. Medi-Cal now covers 13.3 million Californians — one-third of the state’s population.

“California is now serving a huge percentage of Latinos in Medi-Cal,” Kominski said, “and that continues to be seen as underfunded. I think you’ll see increased attention on that.”

The Latino caucus, the largest political caucus in the state, flexed its political muscles last weekend at the state Democratic convention in San Jose.

In contrast to typically sedate, run-of-the-mill convention caucus meetings, the Latino caucus meeting last week was a high-energy event, more akin to a family reunion.

To one side of the front stage, a corner set aside for visiting dignitaries was packed with dozens of political heavyweights — a who’s who of legislators all waiting for their one minute at the microphone to address the crowded room.

“We are a blue state because of this community!” shouted former Los Angeles mayor Antonio Villaraigosa to the cheering crowd. “We are the future!”

While Latinos tend to share an interest in some issues, they are represented across the political spectrum.

A 2014 report by the Public Policy Institute of California showed likely Latino voters register in far higher numbers as Democrats (59 percent) than as Republicans (18 percent) or independents (17 percent). But it also noted that many Latino Democrats are politically conservative. And it found Latino voters are as likely to identify themselves as liberal (34 percent) as they are to call themselves middle of the road (33 percent) or conservative (33 percent).

U.S. Congressman Xavier Becerra, D-Los Angeles, chairman of the House Democratic Caucus and the fourth highest ranking Democrat in the House, said he’s been heartened by the growing political power of Latinos and what he characterized as their enormous legislative accomplishments.

“That wave you see on the horizon, it hasn’t hit the beach yet, but it’s coming,” Becerra said at the state Democratic convention. “You now have Latinos as the top two leaders in the state, behind the governor. There are moments that crystallize in the minds of people, and this is one of them. It’s coming.”

]]>https://ww2.kqed.org/stateofhealth/2016/03/04/latino-political-power-in-sacramento-health-care/feed/2Big Rise in Psychiatric Hospitalizations for California’s Latino Youthhttps://ww2.kqed.org/stateofhealth/2016/03/01/big-rise-in-psychiatric-hospitalizations-for-californias-latino-youth/
https://ww2.kqed.org/stateofhealth/2016/03/01/big-rise-in-psychiatric-hospitalizations-for-californias-latino-youth/#commentsTue, 01 Mar 2016 18:53:17 +0000http://ww2.kqed.org/stateofhealth/?p=155373Psychiatric hospitalizations of Latino children and young adults in California are rising dramatically — at a much faster pace than among their white and black peers, according to state data.

While mental health hospitalizations of young people of all ethnicities have climbed in recent years, Latino rates stand out. Among those 21 and younger, they shot up 86 percent, to 17,813, between 2007 and 2014, according to the Office of Statewide Health Planning and Development. That’s compared with a 21 percent increase among whites and 35 percent among African Americans.

‘Everybody’s trying to hire Spanish-speaking clinicians. There’s just not enough to meet that demand.”Leslie Preston, the behavioral health director of La Clínica de La Raza

No one knows for certain what’s driving the trend. Policymakers and Latino community leaders offer varying and sometimes contradictory explanations. Some say the numbers reflect a lack of culturally and linguistically appropriate mental health services for Latinos and a pervasive stigma that prevents many from seeking help before a crisis hits.

“Often, they wait until they are falling apart,” said Dr. Sergio Aguilar-Gaxiola, a professor at the University of California, Davis Medical School and director of the university’s Center for Reducing Health Disparities.

Others blame stress from the recent recession, family disintegration and an influx of traumatized children fleeing poverty and violence in Central America.

Still others suggest the trend might actually be positive, reflecting an increasing willingness among Latino parents to seek treatment for themselves and their children, at least when they are in crisis.

Among Latino adults, psychiatric hospitalizations rose 38 percent during the same period. Similar hospitalizations of black adults increased 21 percent, while hospitalizations of white adults remained flat.

Margarita Rocha, the executive director of the nonprofit Centro la Familia in Fresno, said mental health issues are starting to be discussed more publicly in the Latino community.

“That’s helping people to come forward,” she said.

Nubia Flores Miranda, 18, works part-time at Family Paths, a counseling and mental health organization in Oakland. Miranda said she became interested in a career in mental health after she started experiencing depression and anxiety her freshman year at Life Academy of Health and Bioscience. (Heidi de Marco/KHN)

Ken Berrick, CEO of the Seneca Family of Agencies, which serves children with emotional disturbances in a dozen counties, agreed. Because more Latinos are now getting mental health services, children are more likely to be identified as requiring hospitalization, he said.

“I know for a fact that access to service is better now,” said Berrick, whose operation has a crisis stabilization unit in Alameda County, Calif.

Kids’ psychiatric hospitalizations overall rose nearly 45 percent between 2007 and 2014, regardless of ethnicity, a pattern experts attribute to various factors including a shortage of intensive outpatient and in-home services, schools’ struggles to pay for mental health services through special education and a decline in group home placements.

“Those kids have to be treated somewhere,” said Dawan Utecht, Fresno County’s mental health director, of the move to keep kids out of group homes.

“If they don’t get those services in a community setting, they’re going to go into crisis.”

The rise among Latino youths is remarkable in part because hospitalization rates for that population historically have been relatively low.

Latino children remain much less likely to receive mental health treatment through Medi-Cal, the state and federal coverage program for poor and disabled residents. Between 2010 and 2014, less than 4 percent of Latino children received specialty mental health services through the traditional Medi-Cal program. That’s compared with 7 percent of eligible black and white children, according to state data. The numbers don’t include those enrolled in managed care.

Nubia Flores Miranda, 18, at her home in Oakland. After participating in the mental health program at Life Academy of Health and Bioscience, Miranda decided to major in psychology at San Francisco State University. (Heidi de Marco/KHN)

(Asian Americans and Pacific Islanders seek treatment at a rate even lower than Latinos. Although hospitalizations are also increasing rapidly among that population, the raw numbers remain relatively small.)

Leslie Preston, the behavioral health director of La Clínica de La Raza, in East Oakland, says that the shortage of bilingual, bicultural mental health workers limits Latino kids’ access to preventive care, which could lead to crises later on.

“Everybody’s trying to hire the Spanish-speaking clinicians,” she said. “There’s just not enough clinicians to meet that demand.”

Access to care can be even harder for recent immigrants. Spanish-speaking children who have been referred for a special education assessment, which can help them become eligible for mental health services, sometimes wait months or years before someone tests them, she said.

Other clinicians point to relatively low health insurance coverage among Latinos, particularly those without legal status, and a cultural resistance to acknowledging mental illness.

Dr. Alok Banga, medical director at Sierra Vista Hospital in Sacramento, said some immigrant parents he encounters don’t believe in mental illness and have not grasped the urgency of their children’s depression and past suicide attempts. Many are working two or three jobs, he said. Some are undocumented immigrants afraid of coming to the hospital or having any interaction with Child Protective Services.

But the biggest problem, from his perspective, is the shortage of child psychiatrists and outpatient services to serve this population.

Jeff Rackmil, director of the children’s system of care in Alameda County, said sheer population growth — particularly, an increase in Latino children insured under Medi-Cal — may also be part of the explanation for the rise in hospitalizations.

Yet the state’s Latino population aged 24 and under increased less than 8 percent between 2007 and 2014, which doesn’t nearly explain an 86 percent increase in hospitalizations.

Elizabeth Ochoa, 17, and Victor Ramirez, 17, work on an assignment during their behavioral health training at La Clínica de la Raza in Oakland. (Heidi de Marco/KHN)

Some California communities are working to bring more Latino children into care and to reduce the stigma associated with mental illness.

At Life Academy of Health and Bioscience, a small, mostly Latino high school in East Oakland, students grow up amid pervasive violence and poverty. “We’re just told to hold things in,” said 17-year-old Hilda Chavez, a senior.

Students often don’t seek help because they fear discussing mental health problems will earn them a label of “crazy,” Chavez said.

Last year, the school, in conjunction with the Oakland-based La Clínica de La Raza, started a program to interest students in careers in mental health care. The program provides training in “first aid” instruction to help people in crisis, and places students in internships with mental health organizations.

Nubia Flores Miranda, 18, participated in the program last year and now is majoring in psychology at San Francisco State University. Miranda said she became interested in a career in mental health after she experienced depression and anxiety during her freshman year at Life Academy.

Seeing a school counselor “changed my life around,” she said.

But she saw that her peers were wary of seeking help from counselors at the school, most of whom were white and lived in wealthier, safer neighborhoods. Once, when a classmate started acting out at school, Miranda suggested she talk to someone.

“She told me she didn’t feel like she could trust the person — they wouldn’t understand where she was coming from,” she said.

Graciela Perez, 17, and Nayely Espinoza, 17, hold up their group assignment during a class presentation at La Clínica de la Raza in Oakland. The students are preparing for their mental health internships. (Heidi de Marco/KHN)

The shortage of services is especially evident in the Central Valley, where many agricultural workers are Latino. Juan Garcia, an emeritus professor at California State University, Fresno, who founded a counseling center in the city, says the drought and economic downturn have exacerbated depression, anxiety, substance abuse and psychotic breaks among Latinos of all ages.

“The services to this population lag decades behind where they should be,” he said.

In Fresno County, psychiatric hospitalizations of Latino youth more than tripled, to 432, between 2007 and 2014. Hospitalizations of their white and black peers about doubled.

Liliana Quintero Robles, a marriage and family therapy intern in rural Kings County, also in the state’s Central Valley, said she sees children whose mental health issues go untreated for so long that they end up cutting themselves and abusing alcohol, marijuana, crystal meth and OxyContin.

“There’s some really, really deep-rooted suffering,” she said.

Out in the unincorporated agricultural community of Five Points, about 45 minutes from Fresno, almost all of the students at Westside Elementary School are low-income Latinos. When principal Baldo Hernandez started there in 1981, he’d see maybe one child a year with a mental health issue. These days, he sees 15 to 30, he said.

He blames dry wells and barren fields, at least in part.

“I’ve had parents crying at school, begging me to find them a home, begging me to find them a job,” he said.

In some parts of the Valley and other places, the closest hospitals that accept children in psychiatric crises are hours away. Children can be stuck in emergency room hallways for days, waiting for a hospital bed.

“It makes for a very traumatized experience for both families and children,” said Shannyn McDonald, the chief of the Stanislaus County behavioral health department’s children’s system of care.

Recently, the county expanded its promotora program, which enlists members of the Latino community to talk to their peers about mental health.

In the small town of Oakdale, a slim, energetic 51-year-old promotora named Rossy Gomar spends 60 to 70 hours a week serving as cheerleader, educator and sounding board for many of the Latino women and children in the town.

Hilda Chavez, 17, at La Clinica de la Raza in Oakland. Chavez says students fear discussing mental health problems will earn them a label of “crazy.” (Heidi de Marco/KHN)

Gomar’s office in the Oakdale Family Support Network Resource Center is cluttered with open boxes of diapers and donated children’s toys and clothing.

“Look at my office,” she laughs. “We don’t fit.”

Gomar says many of the women she works with don’t recognize that they are depressed or abused. Children see their parents’ problems and don’t know where to turn for help.

“There are many young people who don’t have any hope,” she said.

But little by little, she has seen some good results.

One 17-year-old client is a student at Oakdale High School. The girl, whose name is being withheld to protect her privacy, said that earlier this year, problems at school and a break-up with her boyfriend had her struggling to get out of bed each morning. She began drinking, using drugs and thinking about suicide. She was scared to talk to her parents, she said, and kept everything inside.

One day, she walked into Gomar’s office and started crying.

“She told me ‘Everything is ok. We want you here,’” the girl said. “When I was talking with her, I felt so much better.”

]]>https://ww2.kqed.org/stateofhealth/2016/03/01/big-rise-in-psychiatric-hospitalizations-for-californias-latino-youth/feed/1nubia-flores-4Nubia Flores Miranda, 18, works part-time at Family Paths, a counseling and mental health organization in Oakland. Miranda said she became interested in a career in mental health after she started experiencing depression and anxiety her freshman year at Life Academy of Health and Bioscience.latino-kids-1Nubia Flores Miranda, 18, at her home in Oakland. After participating in the mental health program at Life Academy of Health and Bioscience, Miranda decided to major in psychology at San Francisco State University.Elizabeth Ochoa, 17, and Victor Ramirez, 17, work on an assignment during their behavioral health training at La Clínica de la Raza in Oakland. Elizabeth Ochoa, 17, and Victor Ramirez, 17, work on an assignment during their behavioral health training at La Clínica de la Raza in Oakland.students-8Graciela Perez, 17, and Nayely Espinoza, 17, hold up their group assignment during a class presentation at La Clínica de la Raza in Oakland. The students are preparing for their mental health internships.students-9Hilda Chavez, 17, at La Clinica de la Raza in Oakland. Chavez says students fear discussing mental health problems will earn them a label of “crazy.”Latino Children’s Uninsured Rate Hits Record Lowhttps://ww2.kqed.org/stateofhealth/2016/01/15/latino-childrens-uninsured-rate-hits-record-low/
https://ww2.kqed.org/stateofhealth/2016/01/15/latino-childrens-uninsured-rate-hits-record-low/#respondFri, 15 Jan 2016 18:51:36 +0000http://ww2.kqed.org/stateofhealth/?p=139374The rate of Latino children without health insurance fell to a historic low in 2014, the first year that key parts of Obamacare took effect, but they still represent a disproportionate share of the nation’s uninsured youth, according to a new study.

About 300,000 Latino children gained insurance in 2014 from 2013, dropping the number of uninsured to 1.7 million, researchers said. Nearly half of those now insured — more than 130,000 children — were in California

Their uninsured rate fell to 9.7 percent, almost 2 percentage points below the year before. The rate for all U.S. children fell to 6.0 percent from 7.1 percent.

The report released Friday was co-authored by the Georgetown University Health Policy Institute’s Center for Children and Families and the National Council of La Raza, a civil rights and advocacy group for Hispanic Americans.

One reason for the improvement, researchers said, is that the Affordable Care Act produced opportunities for Latino adults to get health coverage, such as providing premium subsidies for buying health insurance in federal and state marketplaces and expanding Medicaid programs in many states. When parents enrolled, they generally signed up their children, too.

States that extended Medicaid to low-income adults had an average 7 percent uninsured rate for Latino children, about half the average 13.7 percent uninsured rate of states that did not expand Medicaid.

Twenty states had rates of uninsured Latino children that were lower than the national average in 2014, the Georgetown-La Raza report said.

Still, Latino children made up 39.5 percent of the nation’s uninsured children in 2014, but only 24.4 percent of the overall child population under 18, according to the report.

Other findings:

Of 10 states with the largest populations of Latino children, California, New York, Illinois and New Jersey were the only ones with uninsured rates below the 9.7 percent national average for 2014. New York’s was 3.8 percent; Illinois, 4.5 percent; California, 6.8 percent; and New Jersey, 7.0 percent.

Four other states in that top 10 group had the highest rates of uninsured Latino children. Georgia and Texas were at 15.3 percent; Arizona, 12.7 percent; and Florida, 12.1 percent.

Colorado and North Carolina, the other two states in the top 10, posted uninsured rates of 9.6 percent and 10.5 percent, respectively. Those were not statistically different from the national average, the report said.

Two-thirds of the nation’s uninsured Latino children lived in Texas, California, Florida, Arizona and Georgia in 2014.

In Texas, 15.3 percent of Latino children were uninsured in 2014, representing 30.6 percent of all uninsured Latino children in the U.S.

]]>https://ww2.kqed.org/stateofhealth/2016/01/15/latino-childrens-uninsured-rate-hits-record-low/feed/0UCLA Researchers Find Health Differences Within Ethnic Groupshttps://ww2.kqed.org/stateofhealth/2015/11/11/ucla-finds-health-differences-within-ethnic-groups/
https://ww2.kqed.org/stateofhealth/2015/11/11/ucla-finds-health-differences-within-ethnic-groups/#commentsWed, 11 Nov 2015 23:50:57 +0000http://ww2.kqed.org/stateofhealth/?p=106635There are major differences in health care status among different types of Asians and Latinos in California — and yet the state so far has resisted treating those subgroups differently, according to UCLA researchers who released an updated version of health survey data last month.

“Data clearly show the need to disaggregate the Asian community and to some degree the Latino community,” said David Grant, director of the California Health Interview Survey.

For instance, he said, the state categorizes “Asian” as an ethnic group, but there are major differences between various Asian subgroups, and a similar trend has developed among various Latino cultures, as well.

“Looking at different groups in the survey information busts a lot of myths,” Grant said. “Most people think about Asians as having health insurance and doing well, but if you break out the subgroups, you see that Koreans have a high uninsured rate of about 47 percent. Also, obesity levels among Asians in general are lower than the state averages, but Filipinos have a higher rate [of obesity] and double the diabetes rate.”

Similar disparities in care and health crop up in the Latino population, too. Different subgroups experience the health care system differently, he said, depending on country of origin.

“Their health needs are far from homogeneous,” Grant said. “And in terms of policy-making it’s clear that different needs apply to different groups.”

One bill dealing with the issue of ethnic subgroups was passed by the Legislature this year, but Gov. Jerry Brown vetoed it.

Brown called the bill “unnecessary” in his veto message for AB 176 by Assembly member Rob Bonta, D-Oakland.

“I am wary of the ever growing desire to stratify,” Brown wrote. “Dividing people into ethnic or other subcategories may yield more information, but not necessarily greater wisdom about what actions should follow.”

“As long as the state puts its head in the sand and fails to acknowledge these differences,” Grant said, “they won’t be able to address the disparities in health care within those groups.”

Grant said the October release of updated survey data could help inform the discussion, for example, about insuring the undocumented population in California or addressing health disparities of specific ethnic population subsets.

“The idea behind the profiles is to highlight information for groups that don’t have a lot of data associated with them,” Grant said. “What’s really unique here is the detailed breakdown of the variety of Latino and other ethnic groups. The power of these data is that we can show … how the communities are different.”

]]>https://ww2.kqed.org/stateofhealth/2015/11/11/ucla-finds-health-differences-within-ethnic-groups/feed/1Santa Cruz Students Track Working Poor with ‘Census of the Invisible’https://ww2.kqed.org/stateofhealth/2015/11/11/santa-cruz-students-track-working-poor-census-invisible/
https://ww2.kqed.org/stateofhealth/2015/11/11/santa-cruz-students-track-working-poor-census-invisible/#respondWed, 11 Nov 2015 19:00:11 +0000http://ww2.kqed.org/stateofhealth/?p=96312Some days, Celia Díaz doesn’t want to get out of bed. But since she’s the major wage earner in her household, she doesn’t have much choice. Six days a week, she drags herself to the Santa Cruz restaurant where she works 10- and 12-hour days as head prep cook. She rarely gets a break and often goes the entire shift without sitting down. She’s developed arthritis in her fingers.
“Here in California, in America, people still aren’t making enough money to survive.”Lizeth Vizcaya, UCSC student interviewer

“There are times I want to quit,” she says in Spanish, while eating a breakfast of tortillas and frijoles in the dim light of her tiny kitchen. “But I can’t, because many jobs pay less for more work.”

Díaz, whose name has been changed to protect her privacy, has to work more than 60 hours a week in order to make ends meet on her $11.50 per hour wage. Still, her paycheck — which never includes overtime pay (she’s paid in cash for anything above 40 hours) —doesn’t come close to covering the cost of living in this coastal California town. She, her husband, their two small children and four other adults share a cramped two-bedroom apartment. A metal-framed bunk bed dominates the living room. The other adults in the house earn less money per hour than Díaz.

They are all members of Santa Cruz County’s working poor. This population of low-wage earners was the focus of a recent UC Santa Cruz study, “Working for Dignity.” Based on interviews with more than 1,300 people, researchers looked at working conditions of the county’s lowest-paid workers, and put a human face on the unseen labor force that supports the base of the Central Coast’s economy.

“This was a ‘census of the invisible,’ ” says lead author Steve McKay, an associate professor of sociology who also directs the UC Santa Cruz Center for Labor Studies. “Our goal was to look at the numbers, but also tell the stories of low-wage workers in Santa Cruz County.”

The report’s release is timely. The Santa Cruz City Council is debating raising the minimum wage and recently commissioned a study looking at the impact of an increase. Other California cities have already begun raising their local minimum wage with San Francisco planning to reach $15 an hour by 2018 and Los Angeles planning to do the same by 2020.

Bridging the Town-Gown Gap

McKay conceived of the “Working for Dignity” study after he was contacted by the Watsonville office of California Rural Legal Assistance. The agency was looking for data on the low-wage earners of Santa Cruz County.

No such data existed.

So McKay launched the project, with an idea to use students to survey low-wage workers. He connected with the Chicano Latino Research Center on campus to train students how to conduct surveys and collect data. He also redesigned his “Work and Society” class into a research-based course. Students learned research methods, and then McKay sent them off on interviews.

Mario, photographed while looking for work at the Day Worker Center in Santa Cruz. (Edward Ramirez)

“There is often a town-gown split in university towns,” says McKay, referring to the divide that can exist between a campus that generally has money and people in the surrounding community who may not. “This project epitomizes the role that the university should play in the state, building new knowledge and training people to identify and respond to the needs of the local community.”

Students met with interviewees at bus stops, parks, laundromats and the farmer’s market in Watsonville’s central plaza. In addition to interviewing workers, students handed out information about workers’ rights and where they could go for help if they suspect their rights are being violated.

More than 100 students were involved in different aspects of the two-year project.

“It was an eye-opening experience,” says Lizeth Vizcaya, a community studies major. She described interviewing a strawberry picker who was paid $9 for each box he filled with smaller cartons of fruit. After sorting through berries and discarding unripe or rotten fruit, labor he didn’t get paid for, Vizcaya says his average wage amounted to $4 an hour. “Here in California — in America — people still aren’t making enough money to survive,” Vizcaya said.

To define low-wage worker, the study used the California Poverty Measure (CPM), an index designed by the Stanford Center on Poverty and Inequality to factor cost of living into the measure of poverty. By that measure, the poverty line for a family of four living in Santa Cruz County is $32,884, or an hourly wage of $15.81. Twenty-two percent of county residents live below the CPM.

“That’s not a living wage – it’s subsistence level,” says McKay. “People will be in real trouble if they fall below that.”

The median wage of those surveyed fell short of that poverty measure — $10 an hour. And, like Díaz, nearly two-thirds of the surveyed group (62 percent) said they were the major earner for their household.

“Just try to imagine living in Santa Cruz on $10 an hour,” says McKay. “It would be really, really tough.”

The result is a vulnerable workforce, living paycheck to paycheck, dependent upon the whim of employers. Interviewees reported a high rate of labor violations, including wage theft, health and safety violations, sexual harassment and racial discrimination. Forty-one percent said they worked overtime hours and, of those, 38 percent did not receive overtime wages. More than seven in 10 (71 percent) said they either did not get breaks or did not get paid for breaks.

There was also racial disparity between the experiences of low-wage white workers versus low-wage Latino workers, the two main racial groups in Santa Cruz County. Of those who worked overtime, 28 percent of whites reported not receiving overtime pay, and 58 percent of Latinos reported not receiving overtime pay.

Putting a human face on labor

A primary goal of the “Working for Dignity” project was to document the human experience behind low-wage labor — and to put a face on the often-invisible working poor. McKay partnered with the university’s Everett Program, which helps students develop skills to generate social change, to create a website that would feature digital stories and photographs of low-wage workers.

James stirs a vat of kettle corn at the Watsonville Farmer’s Market. (Edward Ramirez)

Student Edward Ramirez led the project’s documentary team during his senior year at UC Santa Cruz. Ramirez, a Los Angeles native, was attracted to the project because his parents, who immigrated to the U.S. from El Salvador during its Civil War, had scraped by as low-wage workers throughout his entire life. “I always wanted to give them honor, because society didn’t honor them,” he says.

Working with the local day labor center, Ramirez set out to photograph people who sought day work in various jobs in the area.

One of the biggest rewards for Ramirez was giving the workers their portraits, mounted in wooden frames that he made by hand. “It was great seeing their faces looking at images of themselves,” he says. “They were filled with pride.”

]]>https://ww2.kqed.org/stateofhealth/2015/11/11/santa-cruz-students-track-working-poor-census-invisible/feed/0Veteran2Mario, a day laborer, looks for work at the Day Worker Center in Santa Cruz.Kettle CornJames stirs a vat of kettle corn at the Watsonville Farmer's Market.Mexican Indigenous Immigrants’ Dire Need for Medical Interpretershttps://ww2.kqed.org/stateofhealth/2015/09/28/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields/
https://ww2.kqed.org/stateofhealth/2015/09/28/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields/#commentsMon, 28 Sep 2015 14:45:43 +0000http://ww2.kqed.org/stateofhealth/?p=83818Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what’s happening because everyone is speaking a foreign language.

That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.

The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.

That’s because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.

At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.

“I was scared, but I didn’t have a choice,” she said.

As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.

‘No one explained anything to me. I was scared but I didn’t have a choice.’Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter

Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.

Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”

Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.

That’s why using improvised sign language, or asking a child to interpret — just “getting by” — is simply not good enough, said Fernandez.

“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”

Indigenous Farmworkers Without Interpreters

Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You’re not able to provide equal care to all comers.”

This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).

She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.

“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”

Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.

“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don’t actually speak the language that you need.”

Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book “Fresh Fruit, Broken Bodies.” As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.

In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”

Hospitals may underestimate how many indigenous patients they have — and how many interpreters they need — because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.

“They don’t know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.

Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made California’s 120,000 indigenous farmworkers an explicit priority.

Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.

Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.

“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”

The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.

Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).

Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.

Barriers Remain

Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.

Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.

“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.

“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.

Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.

“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.

The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.

Meanwhile, a bill that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.

Wasted Resource

Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest — and a stack of printed instructions that she couldn’t read.

“I didn’t know what to do,” she said, through an interpreter. “I had strong pain. Should I call them back?”

Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It’s just the kind of confusion that a trained medical interpreter can prevent.

“I just felt very sad,” she said.

Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.

He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next — something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.

But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”

To Vasquez, it’s a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.

This piece was produced with support from the Institute for Justice and Journalism.

California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “Immigrant Shift,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.

]]>https://ww2.kqed.org/stateofhealth/2015/09/28/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields/feed/4Lagnuage mapThis map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED).Brigida Patient3Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby.Argelia (1 of 1)Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.Argelia (2 of 2)Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).For Latinos, Medi-Cal Offers Insurance, But Few Doctorshttps://ww2.kqed.org/stateofhealth/2015/08/10/for-latinos-medi-cal-offers-insurance-but-few-doctors/
https://ww2.kqed.org/stateofhealth/2015/08/10/for-latinos-medi-cal-offers-insurance-but-few-doctors/#respondMon, 10 Aug 2015 21:59:15 +0000http://ww2.kqed.org/stateofhealth/?p=59811SACRAMENTO, Calif. (AP) — Miriam Uribe enrolled in Medi-Cal, California’s low-income health insurance program, last November. But 10 months later, she still hasn’t found a primary care doctor who can see her.

“Once you have (insurance), you actually still don’t have it because it’s still a struggle to find someone,” the 20-year-old college student from Bellflower said.

Uribe isn’t alone. Even though Latinos make up nearly half of California’s 12.5 million Medi-Cal enrollees, a report by the independent California HealthCare Foundation found that 36 percent of the Spanish-speaking Medi-Cal population has been told that a physician won’t take them, compared to 7 percent of the overall Medi-Cal population. Even those who speak both English and Spanish reported similar difficulty accessing doctors.

“The numbers are very, very shocking,” said Sarah de Guia, executive director of the California Pan-Ethnic Health Network, a multicultural health advocacy group.

De Guia said the study doesn’t explain why Latinos — whether they speak English or Spanish — are being turned away at higher rates, but public policy officials say the biggest obstacle is finding doctors who are willing to take the lower payments offered by Medi-Cal. Language barriers also play a role.

The study, which compared people on Medi-Cal to those with employer-sponsored health insurance, found Latinos and Asian-Americans reported the highest rate of needing language assistance to understand their doctor. Specifically, 28 percent of Asian-Americans said their doctor does not listen carefully, compared to 15 percent of all Medi-Cal enrollees.

Shana Alex Charles, a research scientist at the UCLA Center for Health Policy Research who helped conduct the study, said there may not be enough providers who speak Spanish — or there could be an overall shortage of providers in communities of color.

Miriam Lagos, 53, a recent Medi-Cal enrollee who lives in Sherman Oaks, said she was told she has to wait a year just to see a specialist for hearing trouble in her right ear.

“We are not well-regarded by the doctors. They don’t want to see us,” Lagos said in an interview in Spanish.

Medi-Cal, which is California’s version of Medicaid, has grown rapidly in recent years as the state embraced an optional expansion under the Affordable Care Act. That surge has already led to widespread complaints about delays in patients being able to see doctors, specialists and dentists.

Doctors and hospitals say the state pays much less for medical services than private insurance or Medicare, which means fewer primary care doctors and specialists are willing to treat Medi-Cal patients. Lawmakers have convened a special legislative session to discuss increasing provider payments but there is no agreement yet on how to pay for them.

California’s regulators says the state is committed to giving Medi-Cal recipients full and equal access to health care. The Department of Health Care Services says it works with health plans to monitor and reduce disparities in health care, and Medi-Cal provides materials and offers hotline assistance in 13 spoken and 12 written languages.

The California Medical Association, which represents the state’s doctors, encourages its members to be sensitive to language and cultural differences as millions more residents gain access to health care, said spokeswoman Molly Weedn. The group is part of a coalition pushing for higher Medi-Cal provider payments and supports a bill by Assembly Speaker Toni Atkins, D-San Diego, seeking federal funding for medical interpreters in Medi-Cal.

The industry could also do more to train a more diverse medical and clinical workforce, said Xavier Morales, executive director of the Latino Coalition for A Healthy California. A 2014 review by the California HealthCare Foundation found Latinos are underrepresented in the physician workforce: 38 percent of the state’s population is Latino but only 4 percent of physicians were Latino.

“When you look at graduates from medical schools, they don’t really match the population,” Morales said.

Andrea Castillo, 21, a Medi-Cal recipient from McFarland, said it would be nice to see more Latino doctors. Growing up the oldest daughter of farm laborers, Castillo recalls driving long distances to translate for relatives at the doctor’s office.

“You don’t often see a provider who looks like you, who understands you,” Castillo said.

Public health officials are trying to understand why Latino babies are contracting whooping cough at much higher rates than other babies.

California is battling the worst whooping cough epidemic in 70 years. Nearly 10,000 cases have been reported in the state so far this year, and babies are especially prone to hospitalization or even death.

Six out of 10 infants who have become ill during the current outbreak are Latino. Evidence explaining this is inconclusive, but experts have a few theories that range from a lack of Spanish language outreach to Latino cultural practices.

“Hispanics have larger household sizes and there may be cultural practices around visiting new infants that increase the number of contacts,” says Dr. Gil Chavez, deputy director of California’s department of public health.

Babies cannot get their first dose of the vaccine until they are two months old. Some adults may be infected and not know it. The more siblings and extended family members that babies live or visit with, the more exposure they may have to whooping cough.

“Aunts, uncles, grandparents who may not have had a booster shot. They may be passing it on that way,” says Michael Rodriguez, a family physician at UCLA.

However, he points out that several other ethnic groups have large family sizes or live together because financial resources are limited. These factors alone cannot explain why Latino babies are disproportionately impacted.

“It really speaks to the lack of access to health insurance that’s particularly predominant within the Latino community,” says Sarah de Guia, executive director of the California Pan-Ethnic Health Network, an advocacy group.

Latinos make up 62 percent of the uninsured, she says, either because they cannot afford to pay for health insurance, or because they are afraid that signing up for coverage will expose family members who are not lawfully present in the U.S. Many undocumented parents are afraid they will be discovered and deported if they enroll their children, who are legal immigrants or citizens, into government coverage, like Medi-Cal.

“That’s the primary reason why people are not getting the preventive care that they need,” she says –- like whooping cough vaccinations. “And then that impacts everyone.”

Public health officials attribute the ongoing epidemic to several factors.

Whooping cough is cyclical in nature and tends to peak every three to five years. The last outbreak of the disease in California was in 2010.

But doctors are discovering that immunity from the current vaccine may be wearing off on a similar timeline. Medical recommendations suggest booster shots after eight years, but doctors are seeing kids who received a booster three years ago getting sick. Public health officials are currently considering an update to the recommendations to account for the dip in immunity after three years.

Compounding the problem of the vaccine is the fact that many kids in some areas are not getting vaccinated at all. The highest rates of whooping cough are found in the Bay Area counties of Sonoma, Napa, and Marin, which also have some of the highest rates of parents who opt-out of vaccinating their children.

Doctors believe these kids are the root of the current and recent epidemics.

“We had a lot of unvaccinated children that acted as the kindling to start an outbreak,” said Dr. Paul Katz, a pediatrician at Kaiser Permanente in San Rafael. “Those children were able to infect all the other children who were vaccinated but were too early for a booster –- they became the rest of the wood to start the fire.”

All of these factors combine to put babies at risk, especially babies who are not old enough to be vaccinated.

And if Latino children and adults do not have health coverage, they are less likely to be visiting the doctor regularly and getting their booster shots, says Rodriguez.

California’s public health department has done some outreach to encourage pregnant women to get vaccinated in the third trimester, in order to pass immunity on to the fetus. But little outreach has been done in Spanish, and most materials are distributed directly to doctors’ offices –- materials Latinos won’t see if they don’t have insurance and aren’t going to the doctor.

Advocate Sarah de Guia says more work needs to be done so pregnant women –- and adults -– in Latino communities know they need to renew their vaccinations.

“It’s important for public officials to provide culturally and linguistically appropriate outreach to make sure people are getting the message in their language, and in a way they will understand,” she says.

Just over half of all children in California are Latino — that’s more than 4.7 million kids under age 18. In a major new analysis, researchers found a diverse picture of their health and well-being, not just when compared against white children, but also within the Latino population itself.

More than 94 percent of California’s Latino children were born in the U.S., and most of them were born in California.

Fewer Latino children overall achieve a minimum standard of basic health care or family and community environment when compared against white children, and children in households where Spanish is spoken at home have even lower rates.

Still, most parents of these children report that their children are in “good” or “excellent” health.

Researchers found that about a fourth of Spanish-speaking households are considered “linguistically isolated,” meaning no one in the household who is 14 or older speaks English well.

Other findings:

370,000 Latino children in California do not have health insurance, even though they are eligible for government programs such as Medi-Cal, the state’s health insurance program for people who are low income.

Nearly a third (30 percent) of Latino children living in a primarily Spanish-speaking home lives in a working poor household, where parents work full time, but earn less than 100 percent of the federal poverty level.

58 percent of children in primarily Spanish-speaking homes use a community clinic or hospital or a government clinic as their usual source of health care, significantly higher than white children do (15 percent) off Latino children in primarily English-speaking families (18 percent).

While nearly all Latino children were born in the U.S., nearly half (46 percent) of their mothers were born outside of the U.S.

The researchers said their California findings were consistent with a recent national study of Latino children, which also found lower rates of health insurance as well as health disparities.

To address disparities, the researchers recommended the following policies:

Improved access to and quality of health care

Improved early childhood education for every Latino child “as a pathway to school readiness.”

]]>https://ww2.kqed.org/stateofhealth/2014/10/21/portrait-of-health-well-being-in-californias-latino-children/feed/02042946052_a22ba72884_o(Seema Krishnakumar/Flickr)Obamacare No Help to Undocumented Immigrantshttps://ww2.kqed.org/stateofhealth/2014/06/09/obamacare-no-help-to-undocumented-immigrants/
https://ww2.kqed.org/stateofhealth/2014/06/09/obamacare-no-help-to-undocumented-immigrants/#commentsMon, 09 Jun 2014 08:02:25 +0000http://blogs.kqed.org/stateofhealth/?p=19440Morgan Smith, a registered nurse with the Redwood Empire Food Bank Diabetes Wellness Project, conducts free diabetes screenings once a month at the Graton Day Labor Center. The center serves as a conduit between its members — many of whom are undocumented — and health organizations around the region. (Lisa Morehouse/KQED) ( Lisa Morehouse/KQED)

By Lisa Morehouse

California may lead the nation in numbers of people signed up for health insurance under the Affordable Care Act, but there are still millions in the state without health insurance.

‘That leaves a lot of low-wage workers without any health care coverage.’

Some of the people most likely to remain uninsured are undocumented Californians. While they can buy health insurance with their own money, they are specifically excluded from receiving any benefits under the ACA. Community groups and non-profits in cities and towns across California work to fill in the gaps.

One of them is Graton, a small town in Sonoma County, about 20 miles west of Santa Rosa.

When I arrive at the Graton Day Labor Center a woman named Maria is standing behind a table filled with containers of homemade food. There’s oatmeal — with no added sugar, she tells me — tortillas and salsa, fish for tacos, and salad.

Maria (because of her immigration status, we are not using her last name) is selling the food to laborers heading out to work for the day in agriculture, construction and hospitality. They’re all members of the Day Labor Center which connects its members with employers and also does training and advocacy work. Maria makes nutritious food to try to keep her customers healthy. She clearly cares about good health, but she does not have health insurance.

Speaking in Spanish, she first jokes, “I don’t have insurance because I don’t get sick!”

Then she explains the real reason. “It’s because they won’t accept me because I don’t have social security,” she says in reference to a Social Security number.

Maria is undocumented, so she can’t qualify for expanded Medi-Cal or sign up for Covered California.

“This new Obamacare hasn’t helped my situation at all,” she says.

When I ask what would happen if she got really sick, she laughs and holds up a little plastic container. “I’d pass a box around because I couldn’t afford it.”

She’s not alone. Up to a million undocumented immigrants in California are expected to remain uninsured after the ACA is fully implementation in 2019.

“That leaves a lot of low-wage workers without any health care coverage,” says Jesus Guzman, an organizer with the Graton Day Labor Center. “That leaves a population very much vulnerable.”

Earlier this year, State Senator Ricardo Lara proposed a bill which would give undocumented Californians access to expanded Medi-Cal and a dedicated insurance exchange with subsidies available, funded by the state. But the bill is currently on hold in the Senate appropriations committee. Lara’s staff says they’ll be back with another proposal next year. Given that, Guzman says preventive care makes the most sense for the uninsured undocumented immigrants. Access to services and resources can be a challenge.

“What we can do here is serve as a conduit between some of those (health) organizations and the folks that need them.”

Graton Day Labor partners with community health centers and hosts a physician’s assistant once a week. They offer trainings in heart healthy practices, and provide job skill and safety education.

Because diabetes is a huge problem among Latinos, nutrition is another big push. Once a month, the Redwood Empire Food Bank drops off produce at the Graton Day Labor Center. Out of the back of a van, Morgan Smith unloads boxes heavy with lettuce, cabbage, cauliflower, oranges, apples, and sweet potatoes. He also brings special boxes for diabetics.

“This month the box has things like brown rice, dried black beans, high fiber cereal, canned tuna and canned chicken,” Smith says. “Healthy carbos, healthy fats, healthy proteins, about 25 pounds of shelf-stable food, which will hopefully help someone get through the month.”

Smith is also a registered nurse. He and a colleague set up tables in the center’s parking lot. They give free diabetes screenings and share prevention information. Maria and her sisters get in line, and confer about their family health history. Maria holds out her finger for a blood sugar test.

Smith tells Maria her results are normal, and then lets her know about two clinics near where she lives if she has any health needs.

Inside the center, Maria’s sister, Flor, joins other members collecting produce. Like her sister, Flor is undocumented and uninsured. She says that if she got insurance tomorrow, she’d go to the doctor and get check-ups for the whole family. She knows well that preventive care only goes so far.

“A while back my husband was injured in an accident at work,” she explains. “And a bill came, oh my! He had only cut the tip of his finger off, and it cost $10,000.”

Flor says that eventually her husband’s employer paid the bill, but only because her husband had worked for him for so long. Otherwise, she says, she doesn’t know what they would have done.

Lisa Morehouse reported this story for the 2014 California Endowment Health Journalism Fellowship, a program of USC’s Annenberg School for Journalism and Communication.

]]>https://ww2.kqed.org/stateofhealth/2014/06/09/obamacare-no-help-to-undocumented-immigrants/feed/5P1040047Morgan Smith, a registered nurse with the Redwood Empire Food Bank Diabetes Wellness Project, conducts free diabetes screenings once a month at the Graton Day Labor Center. The center serves as a conduit between its members -- many of whom are undocumented -- and health organizations around the region.California Exceeds Its Target for Enrollment in Obamacare Planshttps://ww2.kqed.org/stateofhealth/2014/02/19/california-exceeds-its-target-for-enrollment-in-obamacare-plans/
https://ww2.kqed.org/stateofhealth/2014/02/19/california-exceeds-its-target-for-enrollment-in-obamacare-plans/#commentsWed, 19 Feb 2014 22:10:59 +0000http://blogs.kqed.org/stateofhealth/?p=17786Peter Lee, executive director of Covered California. (Max Whitaker/Getty Images)

With six weeks left to go in the first open enrollment period in Covered California, the state’s health insurance marketplace, California has already exceeded its goal for the number of people it hoped to enroll into health care plans. As of February 15th, 828,638 people have signed up. The original goal had been 500,000-700,000 people by March 31. However, the state is still scrambling to get Latinos on board.

The rate of Latino enrollment showed signs of modest improvement in January. About 7 percent of people who enrolled in health plans through January 31 speak Spanish as their primary language. But the state is still far from mirroring the representation of Spanish speakers in California which is nearly 30 percent.

Overall, Latinos represent 21 percent of sign-ups through the end of January, while that demographic makes up nearly 50 percent of the state’s population.

On Wednesday Covered California launched a new marketing and outreach campaign to try to change this, called “Tengo un plan,” or “I have a plan.”

The new TV commercial and on-the-ground efforts are a response to pressure from advocates and media who have criticized the state for glitches in its Spanish website, the call center dialogue and particularly for not hiring enough Spanish-speaking staff.

“From day one, focusing on Latino enrollment has been probably the number one priority for Covered California,” said Peter Lee, executive director of Covered California. “Have we executed it perfectly? No.”

Latinos as a group are younger and healthier than the general population as a whole. Their premiums are needed to help balance the health care costs of older, sicker Californians and keep premiums down for everyone.

In addition to the Covered California enrollees, another 877,000 Californians are likely to be eligible for Medi-Cal.

Young adults are ticking upward in their enrollment. Of those who have selected a Covered California plan, 26 percent are adults ages 18-to-34 years old. While this group is about 25 percent of the population, it is 36 percent of the people who are eligible for subsidies and would enroll on Covered California.

]]>https://ww2.kqed.org/stateofhealth/2014/02/19/california-exceeds-its-target-for-enrollment-in-obamacare-plans/feed/1187909355Peter Lee, executive director of Covered California. (Max Whitaker/Getty Images)Missteps in Covered California’s Marketing Campaign to Latinoshttps://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/
https://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/#commentsMon, 17 Feb 2014 10:00:57 +0000http://blogs.kqed.org/stateofhealth/?p=17722Screen shot from an early Covered California TV ad targeting Latinos. The on-screen text says people cannot be turned down for pre-existing conditions, but consultants say that is not a key selling point for Latinos.

It’s been decades since the advertising industry recognized the need to woo Hispanic consumers. Big companies saw the market potential and sank millions of dollars into ads. The most basic do’s and don’ts of marketing to Latinos in the U.S. have been understood for years.

“It’s not a cohesive campaign targeted to Hispanics.”

So when California officials started thinking about how to persuade the state’s Latino population to enroll in health care plans, they should have had a blueprint of what to do. Instead, they made a series of mistakes.

“It’s not a cohesive campaign targeted to Hispanics,” says Bessie Ramirez of the Los Angeles-based Santiago Solutions Group, a Hispanic market research firm that has consulted for large health care clients like HealthNet, Cigna and Blue Cross.

“Frankly, it seems obvious that the launch of this program seemed to have actually turned a blind eye to what the needs of this particular consumer were,” she says.

For example, one thing health policy experts love about Obamacare is that no one can be denied coverage for a pre-existing health condition. Covered California made this a selling point in almost all its Spanish ads. But that doesn’t resonate with Latinos. Many have never had insurance, never considered it.

Ramirez says another problem is that all the early TV ads end with a web address for Covered California — no phone number or physical address. She says that completely misses how Hispanics like to shop, especially for a complicated product like health insurance.

“Hispanics are heavily on the Internet, and they’re growing very fast on the Internet; however they’re not transacting on the Internet,” Ramirez notes. “They transact on a personal basis. Hispanics will wait to go to a 7-11 until 11 o’clock. Because at 11 o’clock they know that Juan is on duty.”

Ignoring Cultural Relevance

Perhaps Covered California’s biggest mistake was simply translating ads developed in English for a general audience into Spanish. This ignores the importance of cultural relevance. Think of the award-winning English-language campaign,Got Milk? At worst, a literal translation into Spanish could be a rude reference to breast milk. At best, it just falls flat. That’s what happened with Covered California’s first Spanish-language ad.

The ad features a series of people looking directly into the camera saying, in Spanish, “Welcome to a new state of health. Welcome to Covered California.”

Ad experts say that was an obvious misstep.

“To say we’re in a new state of health for California, it’s grammatically correct to translate it literally, but it doesn’t have the same nuance or cuteness that it does in English,” says Roberto Orci, CEO of Acento Advertising in Santa Monica.

He found one of the state’s follow-up ads just boring — the music, the message and the man in the ad.

“This guy was stiff as a board and … seco, which in English means dry,” he said. “He doesn’t care about my health insurance needs at all.

Latinos Are Key to Health Insurance Risk Pool

If the product is chicken nuggets or milk, it might not matter to anyone but the companies if Latinos buy it. But, if Latinos don’t buy health insurance, it matters to everyone.

It all has to do with the insurance risk pool.On average, Latinos are younger and healthier than the general population. The premiums they pay help cover the health care costs of older, sicker Californians. And that keeps premium costs down for everyone else.

That’s why Covered California is sweating the numbers. Just 6 percent of people who enrolled in Covered California health plans last year speak Spanish as their first language. The state is worried how far that number is from the population of Spanish speakers in the state — nearly 30 percent.

“We don’t think we’ve done a good enough job yet,” says Peter Lee, executive director of Covered California. “Relative to our ambitions and our aspirations we don’t stack up well enough yet, and so we’re going to be doubling down,” he said.

The state spent almost $5 million on its Spanish ad campaign last year. It plans to spend more than $8 million in the first three months of this year. Covered California has upped its market research efforts and vowed to adjust its creative messaging. This time around it will put a lot of emphasis in ads on where people can go to get help in person.

“Even from day one we thought Spanish speakers would need in-person help,” Lee says. “How important that is has really crystalized over the last three months.”

But crucial time has been lost. The final deadline to sign up for coverage this year is March 31. It’s not clear if Covered California can come up with a more effective marketing campaign before then.

This is the first of two stories looking at Covered California’s flaws in enrolling the state’s Latinos. The second part looks beyond marketing to the limited number of Spanish-speaking counselors and other drawbacks.

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https://ww2.kqed.org/stateofhealth/2014/01/21/top-health-concerns-for-u-s-latinos-diabetes-cost-of-care/#respondTue, 21 Jan 2014 17:50:46 +0000http://blogs.kqed.org/stateofhealth/?p=17251(Getty Images)

Latino immigrants in the U.S. say the quality and affordability of health care is better in the U.S. than in the countries they came from, according to the latest survey by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. But many report having health care problems.

About a third of immigrant respondents (31 percent) said they’d had a serious problem with being able to pay for health insurance in the past 12 months. And more than 1 in 4 had a serious problem affording doctor and hospital bills and prescription medicines.

But the health issue that Latinos said is most concerning for them and their families — whether they were born in the U.S. or immigrated here — is diabetes. Last year, in another poll, Latinos said cancer was the biggest problem facing the country.

Hispanic populations have a high prevalence of Type 2 diabetes. About 10 percent of Latino adults have been diagnosed with it or have “prediabetes,” a stage of the disease that often goes undetected.

One important factor: Latinos may be genetically predisposed to the disease — a risk that can be aggravated by environment and diet.

The Diabetes ‘Plague’

Take the example of East Los Angeles, an area heavily populated by Mexican-Americans.

Like many of her friends and family members, Rebecca Martinez-Rocha says she struggles with her weight. At one point, she weighed more than 320 pounds.

“I don’t think I realized it at the time, whether it was denial or I stopped getting on a scale,” she says, “but I was morbidly obese.”

And, as it turns out, Martinez-Rocha was prediabetic, a diagnosis she received at a local health clinic.

“I wasn’t aware of the fact that I was ill; I figured that I was relatively young, in my 20s and early 30s,” she says. “It was kind of one of those ‘aha’ moments in life, where you look at it and put it all together and you think, ‘How did I get here?’ ”

The doctor who diagnosed Martinez-Rocha’s condition is Anne Peters, a diabetes specialist and professor at University of Southern California’s Keck School of Medicine. She’s also the director of a diabetes program at Roybal Comprehensive Health Center.

Peters says Type 2 diabetes is the “plague” of the Latino community she treats: “Individuals here are getting diabetes at rates we’ve not seen before.”

About 12 percent of the Latino population she sees has diabetes. Peters projects that number will climb to nearly 30 percent over the next few decades if nothing changes in the environment or diet of local residents.

Peters told Martinez-Rocha she was on her way to getting insulin-dependent Type 2 diabetes. Martinez-Rocha says she got very scared and made major changes. She lost 160 pounds.

But many patients don’t do that, in large part because prediabetes is often “silent.” Unless people go to a doctor and get their blood sugar measured, they’ll never know they have it.

And that’s a shame, Peters says, because prediabetes can be turned around. “If somebody has prediabetes, they need to lose weight — not a lot of weight, maybe only 10 to 15 pounds,” she says.

They “don’t have to become skinny” to benefit, she adds. Studies show that moderate weight loss can reduce diabetes risk by half.

Losing weight is hard for many people. But Martinez-Rocha says it’s even harder when you live in a neighborhood that offers lots of high-fat, high-salt and high-sugar food.

Alex Ortega, a public health researcher and professor of public health at UCLA, calls neighborhoods like this, where healthy food is hard to come by, “food swamps.”

Walk into the typical corner market, he says, and the first things you’ll see are signs for liquor and lottery tickets, cigarettes, soda and chips. “They might sell some fruits and vegetables, but they’re typically in the back of the store and in very poor quality,” Ortega says.

Our survey found that Latino immigrants generally do not perceive their diets as less healthy in the U.S.: 38 percent see their diet as healthier in the United States, and about the same number (39 percent) say it’s about as healthy. One in 5 (21 percent) see their diet as less healthy.

Previous studies have shown that obesity rates among immigrants increase as their duration of residence in the U.S. increases. They suggest this might be attributable in part to changes in lifestyle, including an unhealthy diet.

About a month ago, Ortega, along with community activists, local high school students and store owner Maria Avila, transformed the Euclid Market in the Boyle Heights section of East Los Angeles. They added windows and a new paint job, and rearranged and organized shelving. But most importantly, Ortega says, they added healthful foods.

The newly converted store opened to the public in December. Today, when you walk in the door, the first things you see aren’t cigarettes and junk food — they’re fresh fruits and vegetables.

This is the fourth corner store in the area to be converted. Ortega is still collecting data, but anecdotally, he says, store owners tell him they have more customers, they’re selling more fruits and vegetables, and they’re making more money.

But the big question is whether the availability of fresh fruits and vegetables will make a difference in the health of the neighborhood and the epidemic of diabetes.

Better Options, Better Diet

For college freshman DeeDee Barba, it has made a difference. She has taken part in the store conversion project for two years. Not only has she learned about marketing and sales, but she’s also learned about nutrition. As a result, she says, her family now eats more healthfully. Part of that includes no dressing on salads.

“We now eat our salads with olive oil and lemon, and it’s actually good,” she says. “We eat a lot of fish and chicken; we rarely eat red meat. We eat rice, but we have whole-wheat rice. We don’t drink soda anymore — we drink mostly water.”

High school senior Steven Cardona, 17, has worked with the store conversion project for the past year. Learning about nutrition, he says, has changed his family’s diet dramatically.

“Before, we would eat lots of fast food, but now we eat mostly steamed vegetables, rice, chicken and lean meats,” he says. Family members have lost a lot of weight, and everybody reports feeling “better,” he says.

Ortega says that’s exactly what’s hoped for: that the availability of healthy food in low-income neighborhoods like this will make a difference in what residents buy, cook and eat. And that it will mean changing diets and reducing the high rates of obesity and diabetes in the Latino community in East L.A.

In Silicon Valley, the executives and engineers who’ve helped build the Apple, Google and Facebook empires earn high salaries and enjoy a slew of perks, including stellar health benefits.

The clients of the Ravenswood Family Health Center, a community clinic in East Palo Alto just two miles away from Facebook’s sprawling headquarters, live in a very different Silicon Valley.

They’re the gardeners, nannies, factory workers and service staff who keep Silicon Valley homes and offices humming, the lawns manicured and the families comfortable.

They are also, in many ways, a microcosm of the population the Affordable Care Act was meant to help.

Many earn between $5 and $15 an hour, don’t own or use computers and are more comfortable speaking Spanish than English. Sixty-five percent of East Palo Alto’s population is Latino, a group seen as crucial to the success of the health law. Many lack health insurance and pose a lower financial risk because they are typically younger and healthier than others.

Yet California, with the greatest number of Latinos in the country, is far behind in reaching this population. And across the nation, the picture appears even worse.

Digital And Cultural Divide

Those who primarily speak Spanish are largely being left out of the first wave of coverage under Obamacare. Many missed the late December deadline for enrollment in plans beginning Jan. 1. People must sign up by March 31 or face a penalty.

In part, the lag in sign-ups among Spanish speakers reflects a digital − and a cultural − divide. Many are hesitant about handing over personal information to strangers over the Internet, advocates say. This group tends to be less educated, and have lower incomes and less access to technology than fluent English-speakers.

When Elizabeth Gonzalez, 31, started getting migraines her doctor prescribed medicine that cost $300. She had health insurance provided through a San Mateo County program for low-income adults, but the medicine wasn’t covered and she couldn’t afford it.

“I guess I don’t need it,” she remembers thinking. Then she started wondering whether the new health law might offer a better plan.

Gonzalez, a part-time library aide, started hunting for resources to help her decipher the Affordable Care Act. Though a Los Angeles native, she was raised in Morelia, Mexico and preferred to have the law explained to her in Spanish.

California’s health insurance marketplace, Covered California, has had a functioning Spanish-language website since Oct. 1 – which puts it ahead of most of the rest of the country. But Gonzalez couldn’t access the site from home because she doesn’t have Internet service or a smartphone.

“With my budget, I don’t have access to that,” she said in Spanish. “I have to limit myself to the primordial.”

Instead, she relied on staff at the county’s human services office, two floors up from the library where she works, to guide her.

Staff members there told her she needed to fill out an application and to wait for up to a month to hear whether she was eligible for Medi-Cal − California’s insurance program for the poor. Discouraged, she made repeated telephone calls to the hotline for Covered California.

“There’s no one picking up, probably because there’s not enough people,” she said. “We need more information in poor communities and places to help you fill out forms so you know you’re doing it correctly. There’s not enough [information] in Spanish.”

According to the latest data released by the state, less than 5 percent of California’s roughly 110,000 signups in October and November were completed in Spanish.

Spanish-speaking operators at Covered California call centers, as well as navigators who can walk people through enrollment, are in short supply. The section on the Spanish version of Covered California for requesting help with enrollment still links to an English website.

In other parts of the country, Spanish speakers are worse off.

‘Big Push’ By March 31

In the 36 states that rely on the federally run insurance exchanges, including Texas and Florida, Latinos until recently couldn’t enroll online in Spanish. CuidadoDeSalud.gov − the Spanish-friendly version of the federal marketplace − wasn’t fully working until Dec. 6, more than two months after its English counterpart, HealthCare.gov, launched on Oct. 1.

Officials decided to hold off opening enrollment on CuidadoDeSalud.gov until they addressed the technical glitches plaguing the English version. Even now, the Spanish website is rife with grammatical errors.

Federal officials note they have bilingual call centers, but Spanish-only calls to the federal exchange’s call centers barely totaled 180,000, or the equivalent of 3.5 percent of all calls, as of Dec. 10.

Unlike English speakers, Latinos who speak Spanish still don’t have the option to window-shop for plans before creating an account. The section in which customers can consult plans before signing up with a username and password is still non-existent in Spanish.

With many Latinos missing the deadline to be enrolled for coverage in the new marketplaces on Jan. 1, community organizers have shifted their attention to March 31, when the enrollment period for 2014 officially closes. Consumers who don’t enroll by this date will face a penalty. Medi-Cal enrollment will remain open, however.

“Most of our community is going to be focused on that March 31 deadline, and that’s where the big push will be,” Jane Delgado, the president and CEO of the National Alliance for Hispanic Health, an advocacy group based in Washington D.C., said earlier this month. “I’m less concerned about getting everybody enrolled quickly than about getting people enrolled in plans that fit their needs. I have no doubt people will enroll. They just need better information and local navigators they can trust.”

Adding to their worries, Latinos living in households with undocumented relatives often fear that signing up for a government run program will lead to unwanted scrutiny and even deportations. Others are wary of getting cheated or having their personal information hacked online.

Mindful of the mistrust, Ravenswood has been careful to develop a bond with its patients.

The clinic has eight certified enrollment counselors to help clients determine what kind of insurance they need and can afford.

“The majority of people coming in are people who we have to help 100 percent. We’re both translating and explaining everything, even when they do speak English,” said Ravenswood CEO Luisa Buada. “In general, everyone really, really wants someone to hold their hand through the whole process.”

‘We Wanted To Be Sure This Wasn’t A Scam’

Maria Garcia, 51, is among the roughly 200 people Ravenswood has screened or enrolled since October 1. Garcia, whose husband supports the family with his manufacturing job, went for help in part because she was concerned about fraud.

“Latinos − we don’t trust easily,” she said. “We wanted to be sure this wasn’t a scam.”

Garcia doesn’t speak English and though she has a computer at home, “I haven’t learned to use it,” she said. She generally relies on her children to search the Web for her and to translate the information she needs.

This time, the staff at Ravenswood helped her. Starting in January, she’ll be paying $36 a month for coverage for her and her husband thanks to a government subsidy.

After her discouraging experiences with the county office and the various hotlines, Gonzalez ended up at Ravenswood as well. It was just across the street from the library. Staffers quickly told her she qualified for Medi-Cal. Her migraine medication will now be covered.

“I was happy,” she said.

Ravenswood’s counselors are booked solid through the end of January. Buada and her staff have set up six enclosed booths, each with a small table, a chair, a Lenovo computer and a wrap-around black-and-white curtain, so that people who don’t have a computer or Internet access at home can feel comfortable coming in.

“We are very good with cellphones or email, but to use that website, you actually have to have access to a computer. That’s a problem,” said the National Alliance for Hispanic Health’s Jane Delgado.

Even with the possibility of federal subsidies, some Latinos can’t afford coverage and will remain uninsured.

The median income for an East Palo Alto household is roughly $50,000, compared to a median income in the county of nearly $90,000. (On average, East Palo Alto households consist of four people compared to three countywide.) Often, 75 percent to 80 percent of a poor family’s income is spent on housing.

“We’ve had a lot of people come in interested,” Buada says. But when they see how much it’s going to cost, “they say, ‘I can’t pay for this,’ and leave.”

Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the Kaiser Family Foundation.